Heights University Hospital

All Charges

Charge

Type

Setting

Price

RADIATION TX MANAGEMENT x 5

Facility

$961.65

Service Code	HCPCS 77427
Hospital Charge Code	85000780
Hospital Revenue Code	333
Min. Negotiated Rate	$144.25
Max. Negotiated Rate	$144.25
Rate for Payer: Qualcare PPO/HMO/WC	$144.25

RADIATION TX MANAGEMENT x 5

Facility

$961.65

Service Code	HCPCS 77427
Hospital Charge Code	85000780
Hospital Revenue Code	333
Min. Negotiated Rate	$125.01
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$288.50
Rate for Payer: Aetna Medicare Advantage	$288.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.22
Rate for Payer: Cigna Commercial	$214.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.01
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$144.25
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RADIATION TX PLANNING

Facility

$385.85

Service Code	HCPCS 77261
Hospital Charge Code	85000370
Hospital Revenue Code	333
Min. Negotiated Rate	$50.16
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$115.75
Rate for Payer: Aetna Medicare Advantage	$115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.39
Rate for Payer: Cigna Commercial	$76.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.16
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.88
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RADIATION TX PLANNING

Facility

$856.45

Service Code	HCPCS 77263
Hospital Charge Code	85000380
Hospital Revenue Code	333
Min. Negotiated Rate	$128.47
Max. Negotiated Rate	$128.47
Rate for Payer: Qualcare PPO/HMO/WC	$128.47

RADIATION TX PLANNING

Facility

$578.50

Service Code	HCPCS 77262
Hospital Charge Code	85000375
Hospital Revenue Code	333
Min. Negotiated Rate	$75.20
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$173.55
Rate for Payer: Aetna Medicare Advantage	$173.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.52
Rate for Payer: Cigna Commercial	$117.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.20
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.78
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RADIATION TX PLANNING

Facility

$578.50

Service Code	HCPCS 77262
Hospital Charge Code	85000375
Hospital Revenue Code	333
Min. Negotiated Rate	$86.78
Max. Negotiated Rate	$86.78
Rate for Payer: Qualcare PPO/HMO/WC	$86.78

RADIATION TX PLANNING

Facility

$856.45

Service Code	HCPCS 77263
Hospital Charge Code	85000380
Hospital Revenue Code	333
Min. Negotiated Rate	$111.34
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$256.94
Rate for Payer: Aetna Medicare Advantage	$256.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.39
Rate for Payer: Cigna Commercial	$184.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.34
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.47
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RADIATION TX PLANNING

Facility

$385.85

Service Code	HCPCS 77261
Hospital Charge Code	85000370
Hospital Revenue Code	333
Min. Negotiated Rate	$57.88
Max. Negotiated Rate	$57.88
Rate for Payer: Qualcare PPO/HMO/WC	$57.88

RADICAL JAW 3 240CM FORCEP

Facility

$46.25

Hospital Charge Code	270653869
Hospital Revenue Code	272
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$23.12
Rate for Payer: Aetna Commercial	$13.88
Rate for Payer: Aetna Medicare Advantage	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.01
Rate for Payer: Oxford Commercial	$23.12
Rate for Payer: Qualcare PPO/HMO/WC	$6.94
Rate for Payer: UnitedHealthcare Commercial	$23.12

RADICAL JAW 3 240CM FORCEP

Facility

$46.25

Hospital Charge Code	270653869
Hospital Revenue Code	272
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$6.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

RADICAL RESECTION OF ELBOW

Facility

$31,743.36

Service Code	HCPCS 24149
Hospital Charge Code	16000821
Hospital Revenue Code	360
Min. Negotiated Rate	$4,761.50
Max. Negotiated Rate	$4,761.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,761.50

RADICAL RESECTION OF ELBOW

Facility

$31,743.36

Service Code	HCPCS 24149
Hospital Charge Code	16000821
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$9,523.01
Rate for Payer: Aetna Medicare Advantage	$9,523.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,094.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,094.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,094.56
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,126.64
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,761.50
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

RADIESSE IMPLNT 1.0CC INJ

Facility

$390.00

Hospital Charge Code	270339131
Hospital Revenue Code	278
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$94.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RADIESSE IMPLNT 1.0CC INJ

Facility

$390.00

Hospital Charge Code	270339131
Hospital Revenue Code	278
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RADIOFREQUENCY GROUNDING PODS

Facility

$69.75

Hospital Charge Code	270663641
Hospital Revenue Code	270
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$10.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.46

RADIOFREQUENCY GROUNDING PODS

Facility

$69.75

Hospital Charge Code	270663641
Hospital Revenue Code	270
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$34.88
Rate for Payer: Aetna Commercial	$20.93
Rate for Payer: Aetna Medicare Advantage	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.79
Rate for Payer: Cigna Commercial	$34.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.07
Rate for Payer: Oxford Commercial	$34.88
Rate for Payer: Qualcare PPO/HMO/WC	$10.46
Rate for Payer: UnitedHealthcare Commercial	$34.88

RADIOLOGY PORT FILMS

Facility

$84.55

Service Code	HCPCS 77417
Hospital Charge Code	85000745
Hospital Revenue Code	333
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$12.68
Rate for Payer: Qualcare PPO/HMO/WC	$12.68

RADIOLOGY PORT FILMS

Facility

$84.55

Service Code	HCPCS 77417
Hospital Charge Code	85000745
Hospital Revenue Code	333
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$25.36
Rate for Payer: Aetna Medicare Advantage	$25.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.56
Rate for Payer: Cigna Commercial	$42.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.99
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.68
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RADIOPAQUE UMB TAPE WHIT 2 24

Facility

$12.29

Hospital Charge Code	270680989
Hospital Revenue Code	272
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$1.84
Rate for Payer: Qualcare PPO/HMO/WC	$1.84

RADIOPAQUE UMB TAPE WHIT 2 24

Facility

$12.29

Hospital Charge Code	270680989
Hospital Revenue Code	272
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$6.14
Rate for Payer: Aetna Commercial	$3.69
Rate for Payer: Aetna Medicare Advantage	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.13
Rate for Payer: Cigna Commercial	$6.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.60
Rate for Payer: Oxford Commercial	$6.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.84
Rate for Payer: UnitedHealthcare Commercial	$6.14

RADIOTHERAPY

Facility

$91,364.01

Service Code	MSDRG 849
Min. Negotiated Rate	$28,648.03
Max. Negotiated Rate	$91,364.01
Rate for Payer: Aetna Commercial	$91,364.01
Rate for Payer: Aetna Medicare Advantage	$29,567.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74,155.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74,155.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30,155.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74,155.23
Rate for Payer: Cigna Commercial	$58,311.15
Rate for Payer: Cigna Medicare Advantage	$30,155.82
Rate for Payer: Clover Medicare Advantage	$28,648.03
Rate for Payer: EmblemHealth Commercial	$90,467.46
Rate for Payer: Humana Medicare Advantage	$31,060.49
Rate for Payer: Oxford Commercial	$36,442.78
Rate for Payer: UnitedHealthcare Commercial	$41,365.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$30,155.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31,965.17
Rate for Payer: Wellcare Medicare Advantage	$30,155.82

RADIOTHERAPY

Facility

$43,187.57

Service Code	APR-DRG 6924
Min. Negotiated Rate	$39,870.85
Max. Negotiated Rate	$43,187.57
Rate for Payer: Aetna Better Health Medicaid	$42,340.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$43,187.57
Rate for Payer: Wellpoint Medicaid Managed Care	$39,870.85

RADIOTHERAPY

Facility

$8,458.60

Service Code	APR-DRG 6921
Min. Negotiated Rate	$7,042.11
Max. Negotiated Rate	$8,458.60
Rate for Payer: Aetna Better Health Medicaid	$8,292.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,458.60
Rate for Payer: Wellpoint Medicaid Managed Care	$7,042.11

RADIOTHERAPY

Facility

$16,219.17

Service Code	APR-DRG 6922
Min. Negotiated Rate	$14,721.87
Max. Negotiated Rate	$16,219.17
Rate for Payer: Aetna Better Health Medicaid	$15,901.15
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,219.17
Rate for Payer: Wellpoint Medicaid Managed Care	$14,721.87

RADIOTHERAPY

Facility

$26,549.80

Service Code	APR-DRG 6923
Min. Negotiated Rate	$21,553.27
Max. Negotiated Rate	$26,549.80
Rate for Payer: Aetna Better Health Medicaid	$26,029.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,549.80
Rate for Payer: Wellpoint Medicaid Managed Care	$21,553.27

Know your out-of-pocket cost for care.

All Charges